外科理论与实践2012，Vol.17Issue(5)：467-471,5.DOI:10.3969/j.issn.1007-1096.2012.05.016
直肠拖出式切除吻合术在低位直肠侧方生长型绒毛状腺瘤中的应用
Pull-through transection and anastomosis for low rectal lateral spreading villous adenoma
傅传刚 1高显华 1王颢 1于志奇 1徐晓东 1王汉涛 1刘连杰1
作者信息
- 1. 第二军医大学附属长海医院肛肠外科,上海200433
- 折叠
摘要
Abstract
Objective To evaluate the application of pull-through transection and anastomosis for low rectal lateral spreading villous adenoma. Methods Sixty-three patients with low rectal lateral spreading villous adenoma operated in our hospital were retrospectively studied. Among them, 28 patients underwent pull-through transection and anastomosis (the pull-through group) and 35 patients underwent transanal local excision(the transanal group). Results All of the 63 patients were preoperatively diagnosed as rectal villous adenoma, and occupied more than 1/2 cycle of the intestinal lumen. Twenty-nine (46.0%) were re-categorized as invasive cancer by postoperative pathological examination (invaded submucosa in 12, invaded muscularis propria in 15 and invaded the whole rectal wall in 2). Two patients had positive mesenteric lymph nodes. Postoperative complications occurred in 3 patients from the pull-through group (anastomotic leakage, wound infection and incomplete intestinal obstruction) and 1 patient from the transanal group (rectal bleeding). No perioperative mortality occurred in both groups. The mean follow-up period was (47.8±18.0)(6-82) months. There were 20 recurrences (57.1%), all from the transanal group. Fifteen of them had multiple recurrences. Two cases had transformed into invasive rectal cancer after multiple recurrences, and underwent Miles procedure eventually. There was still one patient who had multiple lung metastases one year after the last operation. The fecal continence and sexual function were evaluated at 6 months after operation. In the pull-through group, the daily fecal frequency is (4.4±2.2) (2-9) times, with slight fecal incontinence in 5 cases and slight erectile dysfunction in one case. No fecal or sexual impairment occurred in the transanal group. Conclusions The pull-through transection and anastomosis is warranted for low rectal lateral spreading villous adenoma. It is associated with lower recurrence rate, reduced risk of malignancy, less complication and slight disturbance of fecal continence and sexual function.关键词
直肠拖出式切除/直肠绒毛状腺瘤/侧方生长型肿瘤Key words
Pull-through transection and anastomosis/ Rectal villous adenoma/ Lateral spreading tumor分类
医药卫生引用本文复制引用
傅传刚,高显华,王颢,于志奇,徐晓东,王汉涛,刘连杰..直肠拖出式切除吻合术在低位直肠侧方生长型绒毛状腺瘤中的应用[J].外科理论与实践,2012,17(5):467-471,5.
